Prescription Of Antiepileptic Drugs Research Articles

Prescription patterns of antiepileptic drugs in Kazakhstan in 2018: A retrospective study of 57,959 patients

AimThe goal of this retrospective study was to analyze prescription patterns of antiepileptic drugs (AEDs) in Kazakhstan in 2018. MethodsThis study used prescription data of patients with epilepsy who received AEDs in Kazakhstan in 2018. The outcome of the study was the prevalence of use of several AEDs (i.e., valproate, carbamazepine, lamotrigine, topiramate, levetiracetam) in these patients. Demographic variables included age and sex. The present study used descriptive statistics only. ResultsIn 2018, 57,959 patients with epilepsy with at least one AED prescription were found in the LRx database in Kazakhstan. The three most frequently prescribed AEDs were valproate (54.6%), carbamazepine (49.3%), and lamotrigine (16.8%). Interestingly, 10,745 valproate users were women aged ≤40 years. Monotherapy was more frequent than combination therapy and ranged from 80% in patients receiving topiramate to 90% in those receiving carbamazepine. The three most common combination therapies were valproate–carbamazepine (33.7%), valproate–lamotrigine (16.9%), and lamotrigine–carbamazepine (11.8%). ConclusionsPatients with epilepsy were frequently prescribed valproate, carbamazepine, and lamotrigine in Kazakhstan in 2018. Further research is needed to gain a better understanding of the prescription of valproate in women with epilepsy who are of childbearing age.

Treatment patterns in patients with a new diagnosis of epilepsy and psychiatric comorbidities

ObjectiveThe objective of this study was to describe antiepileptic drug (AED) treatment patterns in patients with epilepsy, with and without psychiatric comorbidities. MethodsThis was a retrospective claims-based cohort study using Truven Health MarketScan databases (Commercial and supplemental Medicare, calendar years 2012–2017; Medicaid, 2012–2016). Persons met epilepsy diagnostic criteria, had an index date (first epilepsy diagnosis) with a preceding 2-year baseline (<1 year for persons of 1 to <2 years of age; none for persons <1 year), and continuous medical and pharmacy enrolment without epilepsy/seizure diagnosis or AED prescription during baseline. Based on presence/absence of psychiatric diagnosis codes in the baseline period, persons were classified into two cohorts: with or without psychiatric comorbidities. Outcomes included percentage of treated persons (AED prescription), type, duration, and outcome of first-line AED treatment. ResultsThere were 18,062 persons in each cohort with and without psychiatric comorbidities, matched by age, sex, and insurance type, who met selection (or inclusion) criteria. More patients with psychiatric comorbidities were prescribed an AED after diagnosis (57.6% vs. 52.8%), and had at least two AEDs prescribed during follow-up (16.7% vs. 11.4%) than patients without psychiatric comorbidities. Most patients with and without psychiatric comorbidities prescribed AED monotherapy as first-line treatment (73.0% vs. 78.7%). Levetiracetam was the most common AED prescribed less frequently in patients with than without psychiatric comorbidities (40.8% vs. 56.7%). More patients with psychiatric comorbidities changed first-line AED treatment than patients without psychiatric comorbidities. ConclusionThe presence of psychiatric comorbidities may impact treatment decisions in newly diagnosed persons with epilepsy to optimize patient outcomes.

Did advice on the prescription of sodium valproate reduce prescriptions to women? An observational study in three European countries between 2007 and 2016.

In November 2014, the CMDh (a regulatory body representing EU Member States) advised doctors not to prescribe sodium valproate for epilepsy or bipolar disorder in preg nant women, in women who can become pregnant, or in girls unless other treatments are ineffective or not tolerated. This study aimed to determine if this warning led to changes in prescription patterns. Cohort of 5.4 million women aged between 10 and 50 years identified in electronic health care data from United Kingdom, France, and Italy (2007-2016). Anti-epileptic drug (AED) prescriptions. The prevalence of women receiving AED prescriptions in 2016 varied from 12.2 per 1000 to 29 per 1000 in the four regions. The incidence of prescribing any AED (excluding clonazepam, gabapentin, and pregabalin) fell each year on average by 7.5% (95% CI, 7.0%-8.0%; Emilia Romagna), 9.6% (8.3%-11.0%; France), 7.1% (6.7%-7.6%; Tuscany), and 0.4% (0.2%-1.0%; United Kingdom). The relative odds of prescribing sodium valproate rather than any other AED decreased more after 2014 compared with before the end of 2014 in France (OR = 0.77; 95% CI, 0.60-0.98), Tuscany (0.81; 0.76-0.86), Emilia Romagna (0.83; 0.76-0.90), and the United Kingdom (0.92; 0.80-1.06; not statistically significant). There is evidence that the CMDh warning did lead to changes in prescription patterns of sodium valproate in women of childbearing age. There were considerable differences in prescribing practice amongst regions of Europe.

Do safer seizure medication choices during pregnancy result in fewer birth defects?

In their study “Declining malformation rates with changed antiepileptic drug prescribing: An observational study,” Dr. Tomson and coauthors1 analyzed 14 years of data from pregnant women with epilepsy. Their goal was to find out how seizure medication choices and pregnancy outcomes have changed over time. The data came from an international pregnancy data registry called EURAP.

The Effectiveness of Medical and Surgical Treatment for Children With Refractory Epilepsy

Abstract INTRODUCTION Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families. We aimed to show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr. METHODS The Pediatric Health Information System database was used to study hospitalized children with epilepsy using five published algorithms. Refractory epilepsy (RE) patients treated with either antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery (ES) between 1/1/2008 and 12/31/2014 were included. Patients with a history of ES before 1/1/2008 or a vagus nerve stimulation implantation surgery were excluded. ICD-9-CM codes were used to identify ES. Healthcare utilization following the index date at 2- and 5-yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. Covariates associated with the probability of receiving surgical treatment were chosen in the logistic regression model for calculating PS. SAS 9.4 and Stata 14.0 were used for data management and statistical analysis. RESULTS A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated, respectively. A total of 4050 matched cases, 2025 per each treated group, were included. Overall survival rates of matched cases were 98.07% and 99.58% at 2-yr and 96.66% and 98.99% at 5-yr for medically and surgically treated patients, respectively. Within 5-yr follow-up, seizure-associated healthcare utilization was lower for the surgically treated group: number of inpatient visits were 3.9 vs 2.5 and ED visits were 3.2 vs 1.7 for medically and surgically treated patients, respectively. The number of AEDs at 1-yr follow-up was significantly lower for the surgically treated group (3.22 decreased to 2.59: surgical group, 3.24 decreased to 3.06: medical group). CONCLUSION We found a significant decrease in inpatient and ED visits and number of antiepileptic drug prescriptions, as well as higher survival rates, at 2- and 5-yr follow-up in the surgically treated group compared to the medically treated group for pediatric patients with refractory epilepsy. Pediatric epilepsy surgery can provide beneficial outcomes, favorable long-term effectiveness, and reduced healthcare utilization compared to medical management.

Declining malformation rates with changed antiepileptic drug prescribing: An observational study.

Changes in prescribing patterns of antiepileptic drugs (AEDs) in pregnant women with epilepsy would be expected to affect the risk of major congenital malformations (MCMs). To test this hypothesis, we analyzed data from an international pregnancy registry (EURAP). EURAP is an observational prospective cohort study designed to determine the risk of MCMs after prenatal exposure to AEDs. The Cochrane-Armitage linear trend analysis was used to assess changes in AED treatment, prevalence of MCMs, and occurrence of generalized tonic-clonic seizures (GTCs) over 3 time periods: 2000-2005 (n = 4,760), 2006-2009 (n = 3,599), and 2010-2013 (n = 2,949). There were pronounced changes in the use of specific AEDs over time, with a decrease in the use of valproic acid and carbamazepine and an increase in the use of lamotrigine and levetiracetam. The prevalence of MCMs with monotherapy exposure decreased from 6.0% in 2000-2005 to 4.4% in 2010-2013. The change over time in MCM frequency after monotherapy exposure showed a significant linear trend in the crude analysis (p = 0.0087), which was no longer present after adjustment for changes in AED treatment (p = 0.9923). There was no indication of an increase over time in occurrence of GTCs during pregnancy. There have been major changes in AED prescription patterns over the years covered by the study. In parallel, we observed a significant 27% decrease in the prevalence of MCMs. The results of adjusting the trend analysis for MCMs for changes in AED treatment suggest that changes in prescription patterns played a major role in the reduction of teratogenic events.

Drug Utilization Study in Epilepsy in A Tertiary Care Hospital

Treatment of epilepsy is quite challenging as it requires the antiepileptic drugs to be taken for a long duration, sometimes throughout the lifetime of the patient. But such chronic drug intake results in adverse effects, drug interactions and added economic and emotional distress to the patients. It is therefore of utmost importance to analyze the pattern of prescription of antiepileptic drugs, the concurrent medications in epilepsy. The present study was conducted to collect, assess and understand the above data and also to analyze the rationality and correctness of prescription using the WHO prescription indicators. A total of 100 case records of patients diagnosed with epilepsy was analyzed and the data was recorded. We have total 34 children and 66 adult patients in our study. Generalized tonic-clonic seizures was the common type of seizure. Phenytoin was the most commonly prescribed antiepileptic drug. 1/3rd of the patients needed more than one drug for adequate seizure control and the most common add on drug was levetiracetam. Also, the average number of drugs prescribed to the patients was 6 which included drugs given for concomitant illnesses as well. A total of 561 medicines were prescribed which included the drugs prescribed for concomitant illnesses as well. Average number of medicines per prescription was 6. Prescription by generic name was seen in 42% of the cases. An injection was prescribed in 66% of the prescriptions. An antibiotic was encountered in 38% of the prescriptions. Most of the epileptic patients are subjected to polypharmacy which puts them at a higher risk of side effects, drug interactions and financial burden. Physicians should minimize the use of drugs and look into the rationality of each prescription.

PSY8 HEALTHCARE RESOURCE UTILIZATION AND THE MEDICATION BURDEN IN PATIENTS STARTING PERAMPANEL: A RETROSPECTIVE DATABASE ANALYSIS IN SWEDEN

This analysis examines the healthcare resource utilization (HCRU), including medication burden before and after initiation of perampanel in epilepsy patients compared to matched controls. Patients with at least two inpatient or outpatient diagnoses of epilepsy (ICD-10: G40%) between 01/01/2010 and 12/31/2015 were identified in Swedish national registry data. All patients were observed for 12 months before and after their first antiepileptic drug (AED) prescription documented between 01/01/2011-31/12/2014; and were divided into those who received perampanel during the observational period versus any other AEDs (index date = first prescription of perampanel/any other AED during index period). A propensity score matching was applied to match one perampanel user with five non-perampanel users, based on their baseline characteristics (age, sex, comorbidities, epilepsy duration, number of previous AEDs, year of index AED). After matching, 299 perampanel users and 1,495 controls were identified (mean age 36.6 years; 47.5% female). In perampanel users, number of patients with at least one epilepsy-related hospitalization was reduced by 62.5% (pre-index: 66.9% vs. post-index: 25.1%), in non-perampanel users by 73.0% (pre-index: 45.2% vs. post-index: 12.2%). During the pre-index period, perampanel patients used a mean of 3.3 different AEDs per patient year (py), compared to 1.1 in non-perampanel patients (p<0.001), including the index AED. While average number of different AEDs prescribed in the follow-up period was still higher in perampanel users, a decrease in mean number of prescribed AEDs in comparison to pre-index ([-]0.2 AEDs/py) was observed for perampanel, whereas for non-perampanel users an increase of ((+)1.3 AEDs/py) could be seen (p<0.001). Perampanel users substantially differ in their characteristics from users of other AEDs, with higher HCRU and medication burden, as perampanel is approved as an add-on therapy in a patients with partial-onset seizures. However, after starting on perampanel they experienced a greater reduction in post-index AED use.

PND70 ASSESSMENT OF MIGRAINE PROGRESSION AND PREDICTORS OF PROGRESSION USING A CLAIMS- AND ELECTRONIC HEALTH RECORD-INTEGRATED DATABASE

To determine the rate and identify predictors of episodic migraine (EM) to chronic migraine (CM) progression using machine learning and structured data from a large, geographically diverse claims and electronic health record (EHR) database. A retrospective cohort study design was applied to an integrated claims/EHR data set indexed on first EM diagnosis date. Descriptive analyses were conducted assessing progression rates. Using a hypothesis-free, Bayesian machine learning analytic platform (GNS Healthcare REFS™: Reverse Engineering and Forward Simulation), an ensemble of progression-free survival models was built to predict progression, computationally exploring thousands of variables and their interactions. Accuracy of prediction models was evaluated using Harrell’s C-statistic. The derivation cohort comprised 39,680 adults with an EM diagnosis between 2007 and 2017. In newly diagnosed EM patients, the progression rate after 1-year follow-up was 2.5%. By the end of follow-up, 4.5% of patients had progressed to CM with a median time to event of 377 days. Patients using preventive medications prior to first EM diagnosis had the largest median hazard ratio (HR) for progression; including those with prescriptions for beta-blockers (HR=1.78), anticonvulsants (HR=1.72), and antidepressants (HR=1.52). Other identified risk factors included migraine-related outpatient visits (2+ vs 0, HR=1.52), neurology visits (2+ vs 0, HR=1.49), physical therapy exercise (HR=1.36) and spondylosis (HR=1.32). Male gender (HR=0.69) and older age (75+ vs 18-34, HR=0.24) were protective against progression. All median P-values for listed predictors were <0.001. The mean C-statistic was 0.68 in held-out testing data. Using 10-year real-world data, we determined progression rates for extended follow-up periods, replicated established progression risk factors, and identified novel predictors of progression. Predictors can help clinicians identify at-risk patients and implement timely interventions, thereby reducing migraine progression, improving clinical outcomes, and lowering economic burden.

Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment in the US.

ObjectiveTo estimate the treatment gap between a new epilepsy diagnosis and antiepileptic drug (AED) initiation in the United States.MethodsRetrospective claims-based cohort study using Truven Health MarketScan databases (commercial and supplemental Medicare, calendar years 2010–2015; Medicaid, 2010–2014) and a validation study using PharMetrics Plus Database linked to LRx claims database (2009–2014). Persons met epilepsy diagnostic criteria, had an index date (first epilepsy diagnosis) with a preceding 2-year baseline (1 year for persons aged 1 to <2 years; none for persons <1 year), and continuous medical and pharmacy enrollment without epilepsy/seizure diagnosis or AED prescription during baseline. Outcomes included percentage of untreated persons (no AED prescription) up to 3 years' follow-up and comparative outcomes (incidence rate ratio: untreated persons/treated persons), including medical events and health care resource utilization.ResultsIn the primary study, 59,970 persons met selection (or inclusion) criteria; 36.7% of persons with newly diagnosed epilepsy remained untreated up to 3 years after diagnosis. In the validation study (N = 30,890), 31.8% of persons remained untreated up to 3 years after diagnosis. Lack of AED treatment was associated with an adjusted incidence rate ratio (95% confidence interval) of 1.2 (1.2–1.3) for medical events, 2.3 (2.2–2.3) for hospitalizations, and 2.8 (2.7–2.9) for emergency department visits.ConclusionsOne-third of newly diagnosed persons remain untreated up to 3 years after epilepsy diagnosis. The increased risk of medical events and health care utilization highlights the consequences of delayed treatment after epilepsy diagnosis, which might be preventable.

Antiepileptic Drug Treatment Patterns in Women of Childbearing Age With Epilepsy

Limited population-based data are available on antiepileptic drug (AED) treatment patterns in women of childbearing age with epilepsy; the current population risk is not clear. To examine the AED treatment patterns and identify differences in use of valproate sodium and topiramate by comorbidities among women of childbearing age with epilepsy. A retrospective cohort study used a nationwide commercial database and supplemental Medicare as well as Medicaid insurance claims data to identify 46 767 women with epilepsy aged 15 to 44 years. The eligible study cohort was enrolled between January 1, 2009, and December 31, 2013. Data analysis was conducted from January 1, 2017, to February 22, 2018. Cases required an International Classification of Diseases, Ninth Revision, Clinical Modification-coded epilepsy diagnosis with continuous medical and pharmacy enrollment. Incident cases required a baseline of 2 or more years without an epilepsy diagnosis or AED prescription before the index date. For both incident and prevalent cases, focal and generalized epilepsy cohorts were matched by age, payer type, and enrollment period and then compared. Antiepileptic drug treatment pattern according to seizure type and comorbidities. Of the 46 767 patients identified, there were 8003 incident cases (mean [SD] age, 27.3 [9.4] years) and 38 764 prevalent cases (mean [SD] age, 29.7 [9.0] years). Among 3219 women in the incident epilepsy group who received AEDs for 90 days or more, 3173 (98.6%) received monotherapy as first-line treatment; among 28 239 treated prevalent cases, 18 987 (67.2%) received monotherapy. In 3544 (44.3%) incident cases and 9480 (24.5%) prevalent cases, AED treatment was not documented during 180 days or more of follow-up after diagnosis. Valproate (incident: 35 [5.81%]; prevalent: 514 [13.1%]) and phenytoin (incident: 33 [5.48%]; prevalent: 178 [4.53%]) were more commonly used for generalized epilepsy and oxcarbazepine (incident: 53 [8.03%]; prevalent: 386 [9.89%]) was more often used for focal epilepsy. Levetiracetam (incident: focal, 267 [40.5%]; generalized, 271 [45.0%]; prevalent: focal, 794 [20.3%]; generalized, 871 [22.2%]), lamotrigine (incident: focal, 123 [18.6%]; generalized, 106 [17.6%]; prevalent: focal, 968 [24.8%]; generalized, 871 [22.2%]), and topiramate (incident: focal, 102 [15.5%]; generalized, 64 [10.6%]; prevalent: focal, 499 [12.8%]; generalized, 470 [12.0%]) were leading AEDs prescribed for both focal and generalized epilepsy. Valproate was more commonly prescribed for women with comorbid headache or migraine (incident: 53 of 1251 [4.2%]; prevalent: 839 of 8046 [10.4%]), mood disorder (incident: 63 of 860 [7.3%]; prevalent: 1110 of 6995 [15.9%]), and anxiety and dissociative disorders (incident: 57 of 881 [6.5%]; prevalent: 798 of 5912 [13.5%]). Topiramate was more likely prescribed for those with comorbid headache or migraine (incident: 335 of 1251 [26.8%]; prevalent: 2322 of 8046 [28.9%]). Many women appear to be treated with valproate and topiramate despite known teratogenicity risks. Comorbidities may affect selecting certain AEDs despite their teratogenicity risks.

Examination of the prescription of antiepileptic drugs to prenatal and postpartum women in Japan from a health administrative database.

To evaluate the prevalence and patterns of prescriptions of antiepileptic drugs (AEDs) to prenatal and postpartum women in Japan using a large administrative database. The dates of pregnancy onset and delivery were estimated using published algorithms and infant birth months. The prevalence of prescribed AEDs, the maximum dose of some AEDs, and the frequency of potential combination therapy with AEDs were evaluated for the 180days before pregnancy onset, during pregnancy, and at 180-day postpartum. In total, 33941 pregnant women were eligible for analysis. At least one AED was prescribed to 225 women (66 per 10000 deliveries) between 180days before pregnancy and 180-day postpartum and for 135 women (40 per 10000 deliveries) during pregnancy. The prevalence of AED prescription declined during the first and second trimesters and increased in the third trimester and postpartum. Valproate was the most frequently prescribed drug, followed by clonazepam, lamotrigine, and carbamazepine. Nine (18.4%) of the 49 women with at least one prescription record of valproate in the first trimester were prescribed more than 600mg/day of valproate. Concerning potential combination therapy, 40 (12 per 10000 deliveries) concurrently received two or more AEDs between 180days before pregnancy and 180-day postpartum, respectively, 31 (9 per 10000 deliveries) women received these drugs during pregnancy. Various AEDs were prescribed to pregnant Japanese women. Women of reproductive age should select the appropriate AED before becoming pregnant, depending on the risk benefit profile.

3283 Comparative Effectiveness of Levetiracetam versus Phenobarbital for Infants Aged One Month to One Year, using US Medicaid Claims

OBJECTIVES/SPECIFIC AIMS: Using national Medicaid claims, this retrospective cohort study aims to compare the outcomes of levetiracetam (LEV) versus phenobarbital (PHB) as initial monotherapy in infants with epilepsy aged one month to one year. We primarily analyzed health services outcomes, as follows: (1) Emergency Department (ED) visits: proportion of those with at least 1 ED visit, time to first ED visit, total number of ED visits, proportion leading to inpatient admission (2) Inpatient Admissions: proportion of those with at least 1 admission, time to first admission, total number of inpatient admissions, total length of stay (3) Treatment discontinuation: proportion of those who discontinued medication, time to discontinuation, proportion of those with prescription of second antiepileptic drug (AED) (4) Cost: total cost at 1 year from first prescription. METHODS/STUDY POPULATION: The project is a retrospective cohort study utilizing Medicaid claims from 2009-2012 from all states and DC. Inclusion criteria were: (1) Epilepsy diagnosis (ICD9 345.x) at age 1 month to 1 year (2) 1 year of continuous Medicaid enrollment Exclusion criteria were: (1) Neither LEV nor PHB monotherapy as initial treatment (2) Neither LEV nor PHB prescription within 45 days of epilepsy diagnosis (3) Less than 1 year of follow-up after first LEV or PHB prescription (4) Infantile Spasms diagnosis (5) Brain Surgery (6) Death within 1 year of follow-up Using R for statistical analysis, we analyzed outcomes including ED visits, inpatient admissions, treatment discontinuation, and total cost. In this abstract, we present our preliminary bivariate analysis. RESULTS/ANTICIPATED RESULTS: Demographics and Etiology: Compared to infants prescribed PHB (n = 1954), infants prescribed LEV (n = 1248) were older (median 6 months [IQR 3-9] vs 3[2-6]; p &lt; 0.001), more likely to be white (44.2% vs 38.9%; p &lt; 0.05) and not Hispanic (63.5% vs 58.9%; p&lt;0.05). There were also important differences in epilepsy etiologies (p &lt; 0.05). For example, infants prescribed LEV were more likely to have a diagnosis of tuberous sclerosis (1% vs 0.15%) or traumatic brain injury (12.8% vs 0.56%). Health Services Outcomes: After 1 year, infants prescribed LEV had more ED visits (2 [0-4] vs 1 [0-3]; p &lt; 0.001) but shorter inpatient length of stay when admitted (3 days [2-5] vs 3 [2-6]; p &lt; 0.001). They were less likely to discontinue the medication (46.6% vs 64.3%; p&lt;0.001) but more likely to have a second AED prescription (53.3% vs 43.4%; p &lt; 0.001). Other outcomes, including total cost, were similar. DISCUSSION/SIGNIFICANCE OF IMPACT: This preliminary analysis suggests that the healthcare trajectory of infants treated with LEV and PHB differ in complex ways. In ongoing work, we are conducting a multivariable comparative effectiveness analysis of LEV versus PHB using propensity score weighting to account for observable selection bias and multiple imputation to account for missing data.

Independent role of neonatal seizures in subsequent neurological outcomes: a population-based study.

This population-based study aimed to estimate the impact of neonatal seizures on subsequent neurological outcomes, regardless of underlying etiology. We performed a retrospective cohort study (1st January 2009-31st December 2014), using a USA nationwide claims database. Newborn infants enrolled in 2009 were followed for up to 6years. Neonatal seizures were identified by combining the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 779.0 (convulsions in newborn), procedure codes of electroencephalogram and brain imaging, and antiepileptic drugs claims. Cox regression models were built to estimate the independent impact of neonatal seizures on developing epilepsy, intellectual disability, psychiatric/behavioral disorders, and headache. Out of 490071 newborn infants (251850 males [51.4%], 238221 females [48.6%]), 800 neonatal seizure cases were identified. After controlling for sex, birthweight, preterm birth status, and underlying etiology, neonates with seizures were more likely to have epilepsy (hazard ratio=32.7; 95% confidence interval [CI]=27.7-38.7; p<0.001), intellectual disability (hazard ratio=2.0; 95% CI=1.8-2.3; p<0.001), and headache (hazard ratio=1.6; 95% CI=1.1-2.2; p=0.013) than those without seizures. Observed covariates being equal, seizures in neonates appeared to play a significant role in developing epilepsy, intellectual disability, and headache. The findings showed a detrimental impact of the event in the very early life on neurological outcomes in later life. Seizures had their own impact on the development of adverse neurological outcomes. The magnitude of impact was quite large in epilepsy.

Change in antiepileptic drug prescription patterns for pregnant women with epilepsy over the years: Impact on pregnancy and fetal outcomes.

AIMS AND OBJECTIVES:The objectives of the study were: (1) to determine if there is a change in pattern of antiepileptic drug (AED) prescription during pregnancy in women with epilepsy (WWE) attending a tertiary care institute in North India and (2) to determine if change in AED prescription pattern has resulted in improved fetal and maternal outcomes in WWE.PATIENTS AND METHODS:The current study was a retrospective analysis of records of WWE attending a medical and surgical disorder clinic of obstetrics and gynecology department of a tertiary care teaching hospital in North India. We retrospectively collected data of all the patients during the 5-year period from 2011 to 2015 (Group A) (n = 177) and compared it with our previously published data during the years 1987–1994 (Group B) (n = 219).RESULTS:There was significantly higher use of (i) levetiracetam (LEV) in Group A compared to Group B when women on monotherapy were compared (P<0.0001) and (ii) LEV (P<0.0001), clobazam (P<0.0001) and lamotrigine (P=0.0004) in Group A compared to Group B when women on polytherapy were compared. A significantly higher (P=0.02) number of women were using more than two antiepileptic drugs simultaneously in Group A compared to Group B. There was a significantly higher incidence (P = 0.001) of small for gestational age babies in Group A.CONCLUSION:Although there is an increase in the use of newer AEDs in WWE during pregnancy in North Indian population, it has not resulted in improved maternal and fetal outcomes. (2) to determine if change in AED prescription pattern has resulted in improved fetal and maternal outcomes in WWE.

Predicting drug-resistant epilepsy — A machine learning approach based on administrative claims data

Patients with drug-resistant epilepsy (DRE) are at high risk of morbidity and mortality, yet their referral to specialist care is frequently delayed. The ability to identify patients at high risk of DRE at the time of treatment initiation, and to subsequently steer their treatment pathway toward more personalized interventions, has high clinical utility. Here, we aim to demonstrate the feasibility of developing algorithms for predicting DRE using machine learning methods. Longitudinal, intersected data sourced from US pharmacy, medical, and adjudicated hospital claims from 1,376,756 patients from 2006 to 2015 were analyzed; 292,892 met inclusion criteria for epilepsy, and 38,382 were classified as having DRE using a proxy measure for drug resistance. Patients were characterized using 1270 features reflecting demographics, comorbidities, medications, procedures, epilepsy status, and payer status. Data from 175,735 randomly selected patients were used to train three algorithms and from the remainder to assess the trained models' predictive power. A model with only age and sex was used as a benchmark. The best model, random forest, achieved an area under the receiver operating characteristic curve (95% confidence interval [CI]) of 0.764 (0.759, 0.770), compared with 0.657 (0.651, 0.663) for the benchmark model. Moreover, predicted probabilities for DRE were well-calibrated with the observed frequencies in the data. The model predicted drug resistance approximately 2 years before patients in the test dataset had failed two antiepileptic drugs (AEDs). Machine learning models constructed using claims data predicted which patients are likely to fail ≥3 AEDs and are at risk of developing DRE at the time of the first AED prescription. The use of such models can ensure that patients with predicted DRE receive specialist care with potentially more aggressive therapeutic interventions from diagnosis, to help reduce the serious sequelae of DRE.

Presentation and management of community-onset vs hospital-onset first seizures.

New-onset seizures are frequently encountered in community and hospital settings. It is likely that seizures presenting in these distinct settings have different etiologies and prognoses, requiring different investigation and treatment approaches. We directly compare the presentation and management of patients with community- and hospital-onset first seizures attending the same hospital. We reviewed the medical records of patients aged 18 years or older with discharge International Classification of Diseases, Australian Classification (ICD-10-AM) codes of G40 (epilepsy), G41 (status epilepticus), and R56.8 (unspecified convulsions), who attended a general hospital in Melbourne, Australia, from January 1, 2008, through November 30, 2016. Patients with new-onset seizures were included for analysis. A total of 367 patients were discharged with a relevant ICD-10-AM code. Among them, 151 patients met the inclusion criteria: 97 presented to the emergency department with community-onset seizure (median age 70 years), and 54 experienced seizures during hospitalization for other indications (median age 80.5 years). Provoked seizures were more common in the latter group (26.8% vs 63.0%, p < 0.001), with exposure to proconvulsant drugs a major risk factor. Despite not fulfilling the International League Against Epilepsy (ILAE) diagnostic criteria, 72.5% (58/80) who survived to discharge were prescribed antiepileptic drug (AED) therapy, whereas 19.0% (12/63) of those who met the ILAE criteria were not. Hospitalized elderly patients are at an increased risk of provoked seizures, and caution should be exercised when prescribing potential proconvulsant medications and procedures. A more standardized approach to AED prescribing is needed. Further studies should consider morbidity, mortality, and health economic effects of first seizures and assess optimal management to improve outcomes in this cohort.

Treatment with antiepileptic drugs in patients with stroke. A change in clinical practice may be required

BackgroundStroke prevention is an important socio-economic aim. Epilepsy and antiepileptic drugs (AEDs), roughly divided into enzyme-inducers and non-enzyme-inducers, have been associated with increased risk of stroke. MethodsA retrospective review of patients admitted with a diagnosis of anytime stroke and taking at least one AED was performed. A subgroup of subjects admitted for acute strokes was separately studied. Potential interactions between AEDs and other consumed medications were identified using MicroMedex and Lexi-Interact. ResultsThe study included 827 patients, 59% of them using 5–10 medications. Two thirds of the patients received at least one enzyme-inducer AED, with phenytoin being the most commonly used AED (38% of the patients). Among the subgroup of 82 patients admitted for stroke, 61% were prescribed AEDs after the stroke. More patients had large vessel and embolic strokes among these than among the patients that had strokes while on AEDs. Statins, antiplatelet drugs, antidiabetics and calcium channel blockers (CCBs) were the most frequently used non-AED drugs, by 56, 55, 30 and 28%, respectively. The most common combinations between AEDs and non-AED medications bearing risk for potential major interactions were those of AEDs with statins, warfarin, calcium channel blockers and anti-depressants. ConclusionsA change in the AEDs prescription practice in stroke patients should be implemented, to avoid interactions with major groups of other medications prescribed to these patients.

PND5 - Cost Analysis of Anti-Epileptic Drugs (Aeds) Prescription in Valencian Comunnity, Spain

Analysis of the economic impact, usage and cost of the different therapies prescribed to Epilepsy patients in the Valencian Community, Spain. The patients were indentified through the ATC code N03A, in the database of the Valencian Community where all the prescribed medication information/data is kept, for the 2014. In the analysis, the medication is classified by therapies monotherapy or combination, and by generation of the active drug. There were indentified 26,972 patients that consumed at least one AED, this represents 5,7/ 1000 inhabitants. From these patients, the majority was prescribed second generation AEDs (63.6%), as monotherapy or in combination. The cost of these second generation AEDs was 61.8% of the total costs of AEDs. The Leviracetam (LVT) was the most prescribed AED, a 31.8% of the patients in total, and not taking into account the therapy applied. The prescription of this medication was 43.6% of the total cost of AEDs prescribed. Additionally, the 21.4 % of epileptic patients were prescribed Sodium Valproate (SV), either in mono or combination therapy, resulting as a 4.2% of the total costs. Lastly, analysing the third-generation AEDs prescribed, were 12.8% of the total patients, either in mono or combination therapy. These represented 27.3 % of the total costs, being lacosamide (LCM) the most prescribed. The second generation AEDs continue to be the most prescribed, and with higher costs, being Leviracetam (LVT) the therapy most elected for the treatment of epilepsy. More studies are being conducted to follow-up the trend.

In utero exposure to antiepileptic drugs is associated with learning disabilities among offspring

ObjectivesIn utero exposure to antiepileptic drugs has previously been associated with adverse outcome among offspring, but evidence on longer term milestone development remains limited. We investigated the association between in...